SPECIMEN COLLECTION

The integrity of laboratory specimens and the test results
depends upon proper patient preparation, specimen collection, labeling,
handling, storage and transport.The
test catalogprovides specific
information on container type, volume and special handling requirements for
each test performed at the NPL production center and the most common tests
out-sourced to our reference laboratory.

GENERAL
GUIDELINES

Specific test requirements are found in the alphabetical
test listing in the Northern Plains Laboratory (NPL) test catalog.Please refer to the test catalog or feel
free to call the NPL Call Center at 701-530-5700 with any questions.

For specimen collection tubes containing additives, the tube
usually must be filled to its capacity to ensure the proper blood-anticoagulant
ratio.

If multiple specimen types are being submitted for different
types of testing, label the specimen transport tubes with the specific specimen
type.For example, for a creatinine
clearance indicate which sample is the serum and which sample is the urine.

Reference ranges for therapeutic drugs are often based on
the time the specimens are drawn in relation to the time of the drug
administration.If a drug level is
available as either a peak or trough level, follow the specimen timing
guidelines under the test dictionary.If submitting samples for both trough and peak levels, please remember
to clearly mark the samples as to “peak” and “trough”.

Fasting Specimens

An overnight fast of at least 8 hours is required for most
fasting specimens.Some tests require
a 12-14 hour fast.A specimen collected
under different conditions must be designated non-fasting.If a test has specific fasting requirements,
the requirements will be outlined in the test catalog.

Serum or Plasma

Draw enough blood in the appropriate tube(s) to deliver
sufficient serum/plasma volume, usually 2.5 times the amount of serum/plasma
requested.Allow the tube to fill as
per manufacturers directions.Tubes
with anticoagulant need to be inverted as per manufacturer’s directions.Please note that most plastic serum tubes do
have an additive to initiate the clotting cascade and therefore do require inverting to mix.Allow clotting at ambient temperature, unless otherwise specified
in the individual specimen requirements.Centrifuge the specimen, following the manufacturers recommended spin
time and speed, to separate the serum from red cells within 1 hour of
collection or immediately for plasma separation.Rare testing may require different timing from collection to
sample separation and will be noted in the test catalog.

For any tests that may be sent at room temperature or
refrigerator temperature and collected on gel, the sample may be sent in the
original collection tube provided a complete barrier is formed between the
serum/plasma and red cells during centrifugation.For any tests that require freezing, plasma samples, or non-gel
serum samples, transfer the serum/plasma to an appropriately labeled plastic
transport tube without disturbing the red cell layer.Clearly identify the specimen as serum or plasma.

Whole Blood

Draw sufficient blood in a specimen collection tube with the
indicated anticoagulant for the test(s) ordered.Fill the tube to its vacuum capacity to ensure the proper
blood-anticoagulant ratio.Invert the
tube as per manufacturer’s directions to facilitate mixing and avoid clot
formation.Transport the specimen in
the original tube unless otherwise recommended.If for any reason, a portion of the sample has been removed from
the tube prior to transport to NPL, this should be noted on the specimen and
the requisition to eliminate sample cancellation due what would appear to be
improper fill levels.

Platelet Poor Plasma

Specific requirements for obtaining platelet poor plasma are
under the specific tests it applies to in the test catalog.

CSF/Body Fluids

Transfer to plastic transport vial.

Urine

Sample collection directions are provided in the test
catalog.

Transfer sample to plastic transport vial after thoroughly
mixing the sample to ensure homogenous sample.For 24 hour urine samples, record the total volume on the sample
transport tube.

Cultures

See specific collection techniques under the appropriate
culture in the test catalog.

Venipuncture
Guidelines

Assemble
all supplies necessary to perform the venipuncture.

Wear
proper safety equipment.

Identify
the patient.

Apply
tourniquet above the pre-selected venipuncture site.

Cleanse
selected venipuncture site with alcohol or other approved cleansing agent.

Allow
the area to air dry.

Anchor
the vein.

Perform
venipuncture with needle bevel side up.

Collect
the specimen(s) utilizing syringe or vacuum tube system.

Release tourniquet after successful
venous access.

Remove the needle from site.

Immediately apply direct pressure to
the site with a gauze pad or cotton ball.

Apply a bandage if applicable, after
the bleeding has stopped.

Label all specimens according to
established protocol.

Order
of Draw

Vacutainer and Syringe

The order of tube collection, when drawing either glass or
plastic tubes, is formatted to avoid possible test result error due to cross
contamination from tube additives.

NOTE:When
dispensing blood from a syringe draw, all tubes must be in an upright
position.Theadditives are generally at the bottom of the tube.Don’t invert the tube until the
needle is extracted.

Tube/Additive

Royal
Blue (Plain)

Blue
(sodium citrate)

Red
(Plain)

SST/Red
gel/Gold (clot activator)

Green
(heparin)

Green gel

Lavender (EDTA)

Pink (EDTA)

Tan(EDTA)

Gray
(Potassium Oxalate Sodium Fluoride)

Yellow(ACD)

For all special coag
testing (tests other than PT and aPTT), a discard tube is required.This discard tube must be a citrate tube.

Winged infusion set

When utilizing a
winged infusion set for collection of a coagulation tube, a non-additive or a
coagulation discard tube should be drawn first.The discard tube serves to fill the dead space in the collection
tubing and assure the proper ration of anticoagulant to blood.

Skin puncture

When performing
specimen collection through a skin puncture, the lavender EDTA tube should be
collected prior to the serum tubes to help prevent clots in the EDTA tube.

Specimen Labeling

To assure positive identification and optimum patient
specimen integrity, all specimens submitted to Northern Plains Laboratory must
be labeled accurately and appropriately.As a general rule, two unique identifiers are required for proper
specimen identification.

For clients with a High Volume
Receiver (HVR), the label generated by the HVR must be placed on the transport
tube.

If NPL determines that a label of
any kind below the HVR label has a different patient name or demographic data,
the first label on the tube will be considered the “correct” information.

For clients utilizing a manual
requisition, clearly label the specimen with the first and last name and a
control number label matching the requisition form.

A control number alone without a
written name is not adequate identification.

Northern Plains Laboratory may refuse to accept specimens
that are not appropriately labeled with 2 unique identifiers.In addition, we reserve the right to discard
any unlabeled specimens.There are
specific mandatory blood bank labeling requirements for those sites that NPL
performs type and crossmatch testing.These requirements are available in the test catalog.

SPECIMEN
STORAGE

Specific specimen storage and transport temperatures can be
found in the test catalog for each test.

The time taken for delivery of samples to NPL varies by each
site and by courier.Please utilize the
information in the test catalog to assure the sample will arrive without
exceeding the specified time limits.In
some cases, this requires anticipating longer time frames to arrive at NPL,
such as during heavy postal service holiday.

Specimen
Rejection/Test Cancellation

We reserve the right to refuse specimens if they have been
improperly collected, labeled or transported.The following represent some reasons for specimen rejection:

If recollection of the sample is impossible or would
compromise patient care, it may be possible in some cases to report the result
provided you are able to identify/verify that the specimen is the correct
specimen.At NPL’s discretion, we may
accept the specimen after a verification form is completed and a disclaimer
statement is added to the result.In
any case where specimen recollection is an option, this is the recommended
avenue to ensure accurate results.

INSTRUCTIONS
FOR TEST REQUESTING

Instructions
to clients using manual test request forms

Manual test request forms are available through the NPL Call
Center (701-530-5700).

Attach
one of the set of 3 “sticky” labels provided to each copy of the manual
test request form.

Complete
a separate manual test request form for each patient with the following
information: